GPT and lactic acidosis: Her laboratory workup was significant for transaminitis with aspartate aminotransferase (AST) levels at 478 IU/L, alanine aminotransferase (ALT) at 294 IU/L, and alkaline phosphatase at 703 IU/L, along with direct hyperbilirubinemia with a total bilirubin level 2.9, lactic acidosis, leukocytosis, and a 25% bandemia (Table 1).